Enabling technology for image-guided robot-assisted sub-retinal injections

图像引导机器人辅助视网膜下注射的实现技术

• 批准号: 10248434
• 负责人: IULIAN IOAN IORDACHITA
• 金额: $ 46.84万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-20 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10248434
• 关键词: 3-Dimensional; 4D Imaging; Age related macular degeneration; Anatomy; Animals; Area; Atrophic; Back; Biological; Biological Products; Biological Response Modifier Therapy; Blindness; Cell Therapy; Cell physiology; Cells; Choroidal Neovascularization; Clinical; Complex; Computers; Consumption; Dangerousness; Data; Development; Disease; Drusen; Educational process of instructing; Elderly; Ensure; Environment; Eye; Eye diseases; Foundations; Functional disorder; Future; Gene Transduction Agent; Genetic; Goals; Growth; Hand; Healthcare Systems; Image; Imaging technology; Injections; Institutional Review Boards; Intuition; Location; Macular degeneration; Methods; Motion; Movement; Natural regeneration; Needles; Nonexudative age-related macular degeneration; Operative Surgical Procedures; Ophthalmologist; Optical Coherence Tomography; Patients; Performance; Pharmacology; Photoreceptors; Physicians; Physiological; Physiology; Preparation; Prevalence; Procedures; Reproducibility; Research; Retina; Retinal Detachment; Retinal Diseases; Risk; Robot; Robotics; Safety; Savings; Scheme; Shapes; Signal Transduction; Specialist; Structure of retinal pigment epithelium; Surgeon; Surgical Instruments; System; Systems Integration; Techniques; Technology; Testing; Therapeutic; Therapeutic Agents; Time; Tissues; Translations; Treatment Efficacy; Tremor; Vision; Visualization; base; bevacizumab; care costs; clinical care; cost; design; design and construction; effective therapy; gene therapy; high resolution imaging; human disease; image guided; in vivo; innovation; instrument; interest; man; minimally invasive; nanoparticle; new technology; novel; novel therapeutics; preclinical evaluation; prevent; prototype; retinal damage; retinal imaging; robot assistance; robotic system; sensor; standard of care; stem cell delivery; stem cell derived tissues; stem cell gene therapy; stem cell genes; stem cells; subretinal injection; success; symptom treatment; targeted delivery; tool; virtual; visual information

Project Summary The goal of this proposal is to design, develop and evaluate a novel clinically compatible surgical platform for enhancing the retina surgeon's ability to provide therapy to the subretinal domain. Efficient, safe, reproducible delivery methods would enable safe and precise delivery of stem cell, nanoparticle and gene therapies for prevalent ocular diseases including but not limited to Age-related Macular Degeneration (AMD). The proposed cooperative surgical robot utilizes force-sensing instruments that are guided by 4D intraoperative Optical Coherence Tomography (4D-iOCT) imaging for intuitive surgeon-robot-patient interfaces. It is recognized that precise surgical access to the subretinal and intraretinal spaces would provide novel treatment options for a number of prevalent ocular diseases; the fact that AMD remains the leading cause of blindness in the elderly as well as its extraordinary cost of care makes it a strategic prototype condition for advances in therapy. During the last decade, stem cells and gene therapy have been extensively explored as treatments for AMD. Preliminary results indicate a promising safety profile, and suggest potential efficacy for both. However, translation of these methods into a clinical standard of care has in part, been limited by lack of a method to easily, safely, reproducibly and effectively deliver fully viable agents to the subretinal space. By advancing robotic technology, we seek to safely and reliably enhance access to the subretinal space to allow for the targeted delivery of novel therapeutic agents in the setting of prevalent retinal diseases, such as AMD. Our aims are: (1) Develop and evaluate a clinically compatible cooperative-controlled robotic assistant to enable precise tool manipulation. The enhanced functionality will allow for precise targeted delivery, proper orientation of cells and genetic cargo in the subretinal space, and enhanced survival of therapeutic biological agents; (2) Develop and integrate a novel path planning function to the workstation that will facilitate robot- assisted subretinal injections: utilizing real-time intraoperative 3D OCT images we will detect and track previously invisible subretinal microstructure, optimize approach trajectories to achieve safe, controlled and precise subretinal injections into the target space. Virtual fixtures will be incorporated into the design to avoid dangerous motions; (3) System integration and preclinical evaluation: we will develop assistive control schemes and workflow that fuse the tool-tissue interactions captured by the force-sensing instruments and the visual information provided by the OCT system. In addition, comparison of the new technology against current surgical techniques, in vivo, will be conducted to demonstrate the feasibility of our approach. This highly innovative system will enable surgeons to perform complex maneuvers in a tremor free environment with a higher level of precision than previously possible and with the ability to sense tool-to-tissue interactions that have been previously imperceptible. We envision this development as a logical next step in the integration of man, machine and computer for the performance of unprecedented microsurgical maneuvers.

项目摘要 该建议的目的是设计，开发和评估一个新型的临床兼容手术平台 以增强视网膜外科医生为视网膜下结构域提供治疗的能力。高效，安全，可再现 输送方法将使干细胞，纳米颗粒和基因疗法的安全和精确递送 流行的眼部疾病，包括但不限于年龄相关的黄斑变性（AMD）。提议 合作手术机器人使用4D术中光学指导的力传感器 直观外科医生 - 机场界面的相干断层扫描（4D-IOCT）成像。 人们认识到，精确的手术进入视网膜下和视网膜内空间将提供新颖 多种流行的眼部疾病的治疗选择； AMD仍然是主要原因的事实 老年人的失明以及其非凡的护理成本使其成为战略性的原型条件 治疗的进步。在过去的十年中，干细胞和基因疗法已被广泛探讨 AMD的治疗。初步结果表明安全性有前途，并提出了潜在的功效 两个都。但是，这些方法将这些方法转换为临床护理标准，部分受到了缺乏的限制 轻松，安全，可重复有效地将完全可行的代理传递到视网膜下空间的方法。 通过推进机器人技术，我们寻求安全可靠地增强对视网膜下空间的访问 允许在患有视网膜疾病的情况下进行针对性的新型治疗剂，例如 AMD。我们的目标是：（1）开发和评估临床上兼容的合作控制机器人助手 启用精确的工具操作。增强功能将允许精确的目标交付，正确 细胞和遗传货物在视网膜下空间中的取向，并增强了治疗生物学的存活率 代理人； （2）将新颖的路径计划功能与工作站相结合，这将促进机器人 - 辅助下视网膜注射：利用实时术中3D OCT图像，我们将先前检测和跟踪 视视下微观结构，优化方法轨迹以实现安全，控制和精确 视网膜下注射到目标空间。虚拟灯具将纳入设计中，以避免危险 动议； （3）系统集成和临床前评估：我们将制定辅助控制方案和 融合工具 - 感应仪器捕获的工具组织交互和视觉的工作流程 OCT系统提供的信息。此外，新技术与当前手术的比较 将进行体内技术以证明我们方法的可行性。 这个高度创新的系统将使外科医生在无震颤中进行复杂的动作 与以前可能更高的精确度和能力感知工具与组织的能力更高的环境 以前无法察觉的相互作用。我们将这一发展视为合乎逻辑的下一步 人，机器和计算机的整合，以表现前所未有的微观手术。